The elderly population of the United States is ever increasing as advancements in medical science bring about almost continual progress in the treatment and cure of terminal illnesses and as well as in the science of geriatrics. This is particularly true in the science of pharmacology. New pharmaceutical drugs are being introduced almost daily to address the diseases and disabilities associated with the aging process of the human body.
As a result, more medications are being prescribed today than ever before. In fact, most elderly people are taking more than one medication a day, usually at different times throughout a day. Moreover, the medication is often taken for an extended period of time, especially when the person suffers from a chronic illnesses or other long-term need such as a dietary or hormonal disfunction.
A known problem associated with administering prescription medication to an elderly person is making sure the medication is taken at the appropriate time without skipping or doubling up on any one dose. Consider, for example, an individual taking three different medications a day in different combinations and at different times throughout the day. It can quickly become a logistical nightmare trying to administer the appropriate medication at the appropriate time during the day.
While some elderly people are able to adequately follow their medication administration schedules without creating a risk to their health, many are not able to do so for various reasons, such as the loss of short term memory associated with aging. Further, individuals who are home bound or institutionalized face other difficulties maintaining their medication administration schedules.
A home bound individual is typically under the care of a family member or nurse or both, and therefore must rely on that person(s) to obtain their medication from the local pharmacy in a timely manner. Once they have obtained their medication, the person(s) which cares for that individual must coordinate the administration of the different medications at prescribed intervals of time. This can become quite confusing, as previously discussed, when the individual must take three to fifteen or more different medications, each at a different time throughout the day, especially when more than one person is responsible for administering the different medications. As mentioned, elderly patients often have problems remembering when to take their medication and/or remembering if they even took their previous dose of medication, inhibiting their ability to resolve issues about whether or not they took their previous dose. If no record is available indicating whether the person took their previous dose or not, the individual may become subject to various health risks associated with either missing a dose or overdosing on a subsequent dose.
An inherent problem with the administration of prescribed medication in the conventional format is that neither the pharmacist nor the prescribing doctor have control over the administration of the medication to the person. This is largely due to the cost which would be incurred by having such control exercised by a physician or pharmacist, though, this comes at the cost of placing the health of many individuals at risk if the medication is improperly administered. Another inefficiency of the conventional format is that prescriptions are filled in prescription lots rather than dose lots. This means that a prescription is filled for the needs of a patient over an extended interval of time, typically fifteen to thirty days, wherein all the medication is placed in a single container. Several of the inadequacies of this format for filling prescriptions can be best seen in the nursing home or institutional setting as described below.
Prescription drugs are delivered to long term health care facilities in packages known as blister packs or bingo cards. A months supply of medication for each patient is sent at a time. A typical long term health care facility receives 700 to 1500 of these packages a month. These packages are then filed in cabinets or medicine carts with a compartment for each patient.
Before these medications can be administered to the patients, they must be repackaged into dose lots, and delivered to the patient's room. This re-packaging involves removing the medications for each patient from their file, and sight verifying the medications in each package against the patient's active prescription record. The verified medications are then placed into dose lot cups labeled with the patient's name and room number and transported on mobile carts to the patient's room for administration.
After the medications are removed from their sealed packages, they become subject to contamination and can no longer be fully identified. For this reason, most state pharmacy laws require the medications to be administered in a relatively short time after they are removed from their labeled and sealed packages, unless the system used provides for protection of the medications from contamination and each medication is "fully labeled" in accordance with the packaging and labeling laws and regulations promulgated by the Food and Drug Administration (FDA).
Current art does not provide dose lot medication packaging and dispensing systems permitting medications to remain sealed and fully labeled up to the time of administration. For this reason long term health care facilities are required to package medications into dose lot cups on a daily basis.
Medications are packaged into dose lots by licensed practical nurses (LPN), working under the supervision of a registered nurse (RN). This is expensive and turn over among nurses often results in inexperienced LPN's packaging medications, causing delays in the daily medication of patients.
Present medication administration systems in use permit practically no flexibility as to the time a particular patient can be medicated because the medications must be packaged and delivered to the patients on carts which are pushed from room to room on a rigid schedule, regardless of the patient's whereabouts during the medication schedule. Patients may not be medicated during recreation and meal times and are not always in their rooms when the medication carts come to their rooms. Patients are often being given other treatments during a medication time, or may be simply visiting another patient. The present systems are analogous to shooting at moving targets with a scatter gun. Many patients simply get missed and fail to receive their medications on schedule or miss it altogether.
In regard to automated medication dispensing devices, several improvements have been made in an effort to make a dispenser that will conveniently dispense the appropriate dose of medication at the appropriate time. Examples of such devices are found in U.S. Pat. No. 4,953,745 to Rowlett, Jr., U.S. Pat. No. 5,097,982, to Kedem et al., and U.S. Pat. No. 5,152,422 to Springer. Each of these devices seeks to dispense several different types of medication at predetermined intervals for consumption by a patient. However, none of these devices nor any other device known to the inventor is capable of dispensing medication from a fully labeled, individually sealed configuration into dose lots at programmed intervals for administration to patients.